Correlation Between Double Balloon Endoscopy and Capsule Endoscopy in Presumed Small Bowel Bleeding

Abstract

Background: Capsule endoscopy (CE) is currently the favored modality for small bowel (SB) imaging, and is most commonly used to identify sources of SB bleeding. Double balloon endoscopy (DBE) is a new enteroscopy method which allows direct SB visualization and a range of therapeutic options that can benefit patients with SB bleeding. Aim: To correlate our DBE findings with CE findings in patients with presumed SB bleeding. Methods: Consecutive patients with presumed SB bleeding referred between 9/2004-6/2006 who had undergone CE by their referring physicians were selected from the Fox Chase DBE database. Results: 50 of 65 patients referred for presumed SB bleeding had a prior CE (77%). CE demonstrated a potential source in 31/50 (62%). Potential sources were: AVMs (18), erosions/ulcerations (2), polyps/masses (8), and non-specific or unspecified abnormalities (3). 53 antegrade DBEs in 47 patients and 25 retrograde DBE in 23 patients were performed (total 78 DBEs). Complete enteroscopy (requiring bidirectional DBE) was not specifically attempted in most patients but was achieved in 6 (12%). There was concordance between DBE and CE in 23 patients (46%): 15 patients (30%) had comparable abnormalities (+CE = +DBE) and 8 (16%) had no abnormality on either study (−CE = −DBE). There was discordance in 27 (54%): 11 patients (22%) had a potential source on DBE only (-CE,+DBE), 13 (26%) on CE only (+CE,-DBE), and 3 (6%) had incomparable abnormalities (+CE ≠ +DBE). Conclusions: Concordance between CE and DBE occurred in approximately half of patients with presumed SB bleeding. DBE identifies potentially significant abnormalities in some patients with unrevealing CE. Conversely, the DBE ‘miss’ rate of real CE findings is not yet known. Tabled 1 Concordance Abnormality +WCE = +DBE AVMs (12) Hamartoma (1) GIST (1) Polyp-no tissue diagnosis (1) −WCE = −DBE None (8) −WCE, +DBE AVMs (7) Lymphoma (1) Mesenteric lymphangiomatosis (1) Dieulafoy (1) Granulation polyp (1) +WCE, − DBE AVMs (6) Polyp/mass (3) Ulcerated lesions (2) Inflammation (1) Unspecified 'lesion' (1) +WCE ≠ + DBE Ileal mass≠phlebectasia (1) Polyp≠Erythema (1) Unspecified SB 'lesion'≠GAVE (1) Open table in a new tab